Robotics Vs open-Cut RP ???
The only observations that I can make is that a number of surgeons, and U-Docs said that open was the most reliable, and encourage me to go that way.
Bottom line - If you own a DaVinci machine, then you will want to use it LOTS and LOTS... .. . If you don't own such a machine, then you will be telling all about the problems with such machines (if any).
Now there is a book ( yes - THAT book ) that has reported well on the statistics in Australia..
In other words, robotic nerve-sparing surgery being promoted by the handful of surgeons who have invested heavily in it actually appears to make things worse. Doctors outlaying such investments plainly have a massive incentive to keep up a healthy throughput of patients using the equipment and one of the ways of doing this is to promote the advantages of better surgical outcomes to their patients.
Have a read of pages 71 to 88 - It explains a lot, if you can handle all the statistics.
Some interesting passages...
In other words, it wasn't until Dr Stricker had performed 200 RALP operations, that the incontinence rates he was achieving were equivalent to those obtained by the RRP approach.
Implication - It is harder to get the same 'workmanship quality' with DaVinci.
The JAMA study of 1938 men followed for five years reported that, compared to routine “retropubic” radical prostatectomy, minimally invasive prostatectomy performed via robotic surgery “was associated with an increased risk of genitourinary complications (4.7% versus 2.1%) and diagnoses of incontinence (15.9% versus 12.2%) and erectile dysfunction (26.8 versus 19.2 per 100 personyears)”.
Implication - There are more "Problems" with DaVinci that open-Cut RP.. BUT statistically, is it significant? There is a vague reference to one interesting fact.
With the NSW-wide data showing two thirds of all men undergoing nerve-sparing radical prostatectomy being impotent at three years , it is reasonable to assume that one-year rates of impotency will be substantial.
Unfortuantely, you will find it very hard to get a clear direction from anyone, as each of us chose what we thought was the best, but one thing in common to all, is the thought that the experience of the surgeon is most paramount. But - Remember Dr Strickers belief that you must have 200 DaVinci operations under your belt befor you start to achieve the results of open-Cut RP.
Nov 2009 = First-PSA 5.3 @ 60yo - Asymptomatic - DRE-Non-Palpable
Jan-'10 = TRUS Bx DX - AdenoCar T1c - GS(3+3)=6 , 5 & 45% max., L-MidZone
May-'10 = RRP-Nrv-Spare
Post Op. GS(3+4)=7, 1.1cm3, Pos Margins, EPE (focal) Lateral Left
Margin-Involvement (extensive) Posterior , Grade3 x 8mm
+8week PSA<0.01, ED-85%, Incont-30%
+16W PSA<0.01, ED -85%, Cont -5%
+17W First 'DRY' day. ED -90%